Painful bladder syndrome (PBS) is a long-term, painful condition of the bladder, the exact cause of which is unknown, although there are many theories. Interstitial cystitis (IC) is a subtype of painful bladder syndrome where specific inflammatory changes in the bladder are present at cystoscopy (a telescope examination of the bladder). The exact cause of this condition is unknown, and its diagnosis is one of exclusion (i.e. other bladder conditions are excluded by further testing). 90% of affected people are women, most commonly in their 20s to 40s.
What are the symptoms of Interstitial cystitis / Painful Bladder Syndrome?
The key symptoms of Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS) are pain, frequency of urination and urgency (the urgent desire to pass urine). The pain or sensation of bladder discomfort/pressure in IC / PBS is felt classically as the bladder fills with urine and is usually relieved by urination. The sensation of bladder discomfort drives the need to urinate and results in frequency of urination, usually both day and night. Symptoms can begin gradually or suddenly and with no apparent reason. In mild forms of IC / PBS or in the early stages of IC / PBS, symptoms may occur as transient attacks known as “flares” which may be mistaken for urinary tract infections. It is therefore important to have a urine culture to help distinguish these symptoms from a bacterial urine infection.
How is Interstitial cystitis / Painful Bladder Syndrome diagnosed?
There is unfortunately no simple single test that diagnoses Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS).
IC / PBS is essentially a diagnosis of exclusion – i.e. the patient must have the characteristic features on history and examination of IC / PBS AND other conditions that can be confused with IC / PBS are ruled out e.g. overactive bladder, urinary tract infection, other bladder pathologies such as cancer and bladder stones, etc.
Some of the tests that may be performed to rule out other bladder conditions include:
- Urine samples – to test for infection and abnormal cells in the urine
- Cystoscopy – or telescopic examination of the bladder lining to exclude other bladder pathologies
- Cystoscopy and bladder hydrodistension (performed under a general anaesthetic) – during which the bladder is stretched with sterile fluid using a telescope
- Urodynamic tests
A patient may still have IC / PBS even if all these tests are normal, if they exhibit all the symptoms of interstitial cystitis / painful bladder syndrome.
What are the treatment options for Interstitial cystitis / Painful Bladder Syndrome?
There are many treatment options available for Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS). Unfortunately, there is no cure for this condition and no single treatment that works for all patients. The choice of treatment will depend on the severity and type of the patient’s symptoms, as well as patient and doctor preferences. Different treatment options are tried until good symptom relief is achieved. Often “multimodal treatment” is recommended for patients with IC / PBS, which encompasses:
- Dietary changes
- Physical therapies including education in pelvic floor relaxation
- Cystoscopy and hydrodistension – This can be both diagnostic and therapeutic in IC / PBS.
- Oral medications including Amitriptyline (Endep®) and Elmiron® (pentosan polysulfate or PPS), and others that can modulate pain.
- Bladder instillations – which involve the instillation of a chemical solution directly into the bladder using a catheter with medications such as DMSO (dimethyl sulfoxide) or Chlorpactin®
- Many other treatment modalities have been tried, some of which are experimental, and some of which are only indicated in severe forms of the condition.